Theodore B. Shybut, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas Phone: Fax:

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1 Theodore B. Shybut, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas Phone: Fax: BICEPS TENODESIS PROTOCOL This rehabilitation protocol has been developed for the patient following a tenodesis (reattachment) of the long head of the biceps tendon surgery. This protocol will vary in length and aggressiveness depending on factors such as: Quality of the repaired biceps tendon tissue Presence of additional procedures such as shoulder arthroscopy Degree of shoulder instability or weakness or deconditioning prior to surgery Acute versus chronic condition Length of time immobilized Strength/pain/swelling/range of motion status Rehabilitation goals and expectations Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. The protocol is divided into phases. Each phase is adaptable based on the individual and special circumstances. The overall goals of the surgical procedure and rehabilitation are to: Control pain, inflammation, and swelling Regain normal upper extremity strength and endurance Regain normal shoulder range of motion Achieve the level of function based on the orthopedic and patient goals Physical therapy should be initiated after the first week post-op. The supervised rehabilitation program is to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility. Important post-op signs to monitor: Swelling of the arm or shoulder and surrounding soft tissue Abnormal pain response, hypersensitivity, increasing night pain Severe range of motion limitations Weakness in the upper extremity musculature Improper mechanics or scapular dyskinesia Core and peri-scapular strength deficits Return to activity requires both time and clinical evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Functional evaluation including strength and range of motion testing is one method of evaluating a patient s readiness return to activity. Return to intense activities following a biceps tenodesis requires both a period of time to

2 allow for tissue healing along with a graduated strengthening and range of motion program. Symptoms such as pain or swelling should be closely monitored by the patient and therapist. Specific exercises may be added, substituted, or modified where clinically appropriate by experienced sports/shoulder therapists or trainers who have expertise in the care of post-operative tendon repair procedures. While patients may be "cleared" to resume full activities at 6+ months following surgery, additional time spent in full activity or sport participation is often necessary to achieve maximal recovery. Following biceps tenodesis, no resistive biceps work should be performed for 6 weeks.

3 BICEPS TENODESIS PHASE 1: WEEK 1-2 Focus of this phase is symptom reduction, P, and protection of the repair Gradual Passive of shoulder in all planes Pendulum exercises keep circles small Elbow: Passive flexion and gentle passive extension Forearm: passive pronation and supination Wrist/hand/finger full A STRENGTH Sub-maximal shoulder isometrics in all planes Scapular retractions Shoulder shrugs Supine rhythmic stabilizations Wrist/hand: grip strengthening BRACE/SLING Brace for 4 weeks or as noted by Dr. Shybut Brace removed to perform exercises above Hot pack before treatment E-stim, TENS as needed Ice minutes after treatment GOALS OF PHASE 1 Promote healing of repaired tendon Control pain and inflammation Gradual increase of Independent in HEP Delay muscle atrophy PHASE 2: WEEK 2-6 Focus of this phase is protection of repair, gradual increase in and strength Continue P and pendulums Initiate AA shoulder o Rope/Pulley into flexion and scaption o Supine cane/wand into flexion and ER Initiate gentle posterior and inferior shoulder mobilizations Elbow: Initiate AA flexion and extension, progress to active flexion and extension (week 4) Forearm: Initiate AA pronation and supination, progress to active pronation and supination (wk 4)

4 STRENGTH Continue scapular stabilizer strengthening: shrugs, shoulder retraction Continue grip strengthening as needed Initiate UBE with no resistance, forward only (week3) Prone rows do not load biceps Resisted scapular retractions with bands Standing flexion and scaption Prone extension Side-lying ER ER with band Side-lying flexion Supine serratus punches Triceps Initiate IR walkouts with thera-band (week 5+) BRACE D/C wk 4 per Dr. Shybut Heat/hot pack before therapy E-stim as needed Ice minutes GOALS OF PHASE 2 Control pain and inflammation Initiate light controlled loads on repaired tissue Gradual increase in Increase activity tolerance and muscular endurance PHASE 3: WEEK 6-12 Focus of this phase initiate biceps strengthening and progress RC and scapular strengthening Goal is to be near full A wk 8 Continue/progress all work from previous phases Initiate Grade II-IV joint mobs as needed STRENGTH UBE forward and backward May begin biceps curls at week 6-8 per Dr. Shybut Initiate resisted forearm supination and pronation at week 8+ Continue previous shoulder strengthening: o Shoulder retraction with resistance o Supine punches with resistance

5 Prone shoulder extension Prone rowing May gradually progress rotator cuff and detoid strengthening, advance bands as tolerated after week 8 Rhythmic stabilizations Initiate 2-handed plyotoss at chest week 12 Ice minutes GOALS OF PHASE 3 Minimize pain and swelling Reach full Improve upper extremity strength and endurance Enhance neuromuscular control Normalize kinematics PHASE 4: WEEK 12+ Focus of this phase is functional activity/sports specific strengthening STRENGTH: Progress strengthening program with increase in resistance and high speed repetition Initiate IR/ER exercises at 90 abduction Progress rhythmic stabilization activities to include standing PNF patterns with tubing Initiate single arm plyotoss Initiate military press, bench press, flys, lat pulldowns week 16+ UBE for strength and endurance Initiate sport specific drills and functional activities Initiate interval throwing program week Initiate light upper body plyometric program week Progress isokinetics to 90 abduction at high speeds Ice minutes GOALS OF PHASE 4 Full painless Maximize upper extremity strength and endurance Maximize neuromuscular control Optimize shoulder mechanics/kinematics Optimize core stability Initiate sports specific training/functional training

Theodore B. Shybut, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas Phone: Fax:

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